BP-69852 Permit No. BP-69852 BUILDING PERMIT
GIs#: 334s.00 ) Commonwealth of Massachusetts
_Map: U066 - TOWN OF DARIMOUTH
Lott:' 400 Slocum Road,Dartmouth,MA 02747
Sub-Lot: '` U131 I - Phone:(508)910-1820 • Fax:(508)910-1838
Category: AGP
_Project# JS-2013'-002463 _ PERMISSION IS HEREBY GRANTED TO:
Est.Cost: 55800.00 ' Contractor: License:. Phone#•
Fee:. $80.00'. : AARON POOLS&SPA (508)996-3320
_Const.Class: Engineer. .License: Phone#:
Use Group: U -
Lot Size(sq.ft.).- 41000 Applicant. Phone#:, ,.
Zoning: SRB KATHLEEN BOGIE . (508)9954660
Aquifer Zone: N/A OWNER:
Flood Zone: ZONE X BOGIE CHRISTOPHER D
Alt oast: .NIA b�'P- 3 Alt Const: N/A DATF. ISSUED:
Date Typed: 05-22-2013 '.. . .
TO PERFORM THE FOLLOW4IYG WORK:
Installation of a 21' a ve gro d swimming pool with a.: r .riate-barriers
gyp` 1 'eci /f r cat , t�:WREN LN
Approved/Issued By: 1. (
PAUL M URPHY,DIRE 7 . • OF INS?:CFIONAL SERVICES
All work shall comply with 780 CMR WE Ed.(MGL Chap.143)and any oth r applicable ass.Laws or Codes and plans on file.
: Schedule appropriate inspections as required. Upon completion of work,ft • ins, ',n is required.
I hereby certify that the proposed work is authorized by the owner of record and I have been authorized by the owner to make this application as his agent
and to receive this permit, 1 further understand other agencies may have reason to STOP WORK if items under their jurisdiction are not met; not
withstanding the issuance of this Building/Zoning Permit.
Signature of Owner.'Agent: _ (/tt1l.(.i4-{_
"Persons con tractingwith unregistered contractors do not have access to the guaranty fund(as set forth in MGL c.142A)"
Inspector of Inspector of D.P.W.Inspector Building Inspector Inspector of Gas Fire Department
Plumbing Wiring
Water Service ft: Footings: Underground: Oil:
Underground: Service:
Foundation:
Rough: Smoke:
Rough: Rough: Sewer Service#: Rough Frame:
Insulation: Final:
Final: Final:
Cross Connection Final: Final:
.. - ___4--_ Treasury:
Board of health E-911
Additional Comments:
Planning Board
Prior to issuance of Certificate of Occupancy/Completion,this card must be returned to the Building Department with all necessary
inspections signed off. Department phone numbers are listed on the white"Required Inspections"document provided with the issuance of
the building permit.
POST CARD SO IT IS VISIBLE FROM THE STREET
i.
TOWN OF DARTMOUTH BUILDING DEPARTMENT RECEIPT 6 9 8 5 2
PHONE: 508210-'t8 l 'LLT
Name: A ( �° PrperryOwner $JLtIESD %z'g/3
Job Location: r.� / , r�. <.A.„.4 ' 1,_, r.. Map: Lot:G /2/
Description General Ledger#'s Ref.# Amount
Building& Building Misc. 01000-44105 6 l
Electrical 01000-44106 `• MJS 4
Plumbing & Gas 01000-44107 MAY 1 4 2013
Trench Safety 01000-44129 A 8
Other Department Revenue 01000-42420 kCOLLEE4
White-Collector's Office Yellow Copy-Customer's Receipt Pink Copy-Building Department Received By ' ``---
THIS IS NOT A PERMITILICENSE FOR BUILDING, ELECTRICAL,✓PLUMBING OR GAS
RESIDENTIAL 0 Phased Approval R106.3.3)
$25.00 APPLICATION FEE IS NON BE-FUNDABLE &NON-TRANSFEIIABLE
ourH. Fhl-,r VLRATE RECEIVED
• ,.4 >.\ DARTMOUTH BUILDING DEPARTMENT s i ,, ,!)�
eif 400 Slocum Road, P.O. Box 79399
4.DfPT.
O S�
x Dartmouth, MA 02747 7013 HAY I p1n 4: 0�
,fib /' Phone: 508-910-1820 Fax: 508-910-1838
- � www.town.dartmouth.ma.us
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
THIS SECTION FOR OFFICIAL USE ONLY _^
RECEIVED BY: BUILDING PERMIT NUMBER: G �S ;4-
DATE ISSUED:
SIGNATURE: ,tC/---- /(//i,( ' DATE: 01/73
Building Commissioner sp-, •f Buildings
Zoning District: 5 i r % Proposed Use: Y - 3 Zone: . X-A B s-A--B-V Aquifer Zone.
THE FOLLOWING AGEN IES SHOULD BE NOTIFIED:
❑Board of Board of 0 Cons. 0 Demo ❑DPW 0 Elec. 0 Energy Report
Appeals Health Commission Affidavit Card Sent: Cut Off Follow-up'
❑Fire 0 Gas 0 Planning 0 Sewer Card 0 Water Card 0 Zoning 0 Other
Chief Cut Off Board Cut Off Cut Off
*REQUIRES INSPECTOR'S REVIEW BEFORE THE ISSUANCE OF A PERMIT. ,
EP RT ENT L OVAL Board of Health: Signature: Date: 542 1__ r)
Conservation Commission: Signature: Date:
Other: Signature: Date:
r
Signature: Date:
Signature: Date:
Brief description of work being performed: L.'sTt-LA- a R- -4Q B`P Sai• 14ti3- '< A -&. PaoL
SECTION 1 -SITE INFORMATION
1.1 Property Address: 3 w(2Lc9 LN • 1.2 Assessors Map&Lot Number: 7
Lot Area(sf.) Frontage Map (` /t
,�f.. Lot A - I D
--i Required Provided
Front Yard 1.3 Historical District 0 Yes 0 No
Side Yard
Rear Yard Year Built
0 Altering more than 25%per side of building
1.4 Water Supply(MGL c40 s54): 1.5 Sewage Disposal/ System: Has application been submitted to the Historic Commission?
❑ Municipal r.ivate Well ❑ Municipal ta'61n Site Disposal System 0 Yes 0 No Date:
Revised 10/11
15 CONSTRUCTION PLANS ❑ SITE PLAN ❑ ENERGY REPORT
RESIDENTIAL
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner Record: (�- (SC(i) (MS
1/
IATHLtea/ tR,CGiE -� Lk)w�.) LAal[ / k),5\a-rn 86G°
' Name(print) Contact Address M A p c -7 Phone Number
2. Authorized Agent:
oN t rss stzSuro $Th 7 S tp-rc as). (f4ti) • 3333C�
Name(print) Contact Address Phone Number
SECTION 3-CONSTRUCTION SERVICES
•
3.1 Licensed Construction Supervisor/Specialty License: License Number: 14c3'3 .3
Company Name/Contractor Name: AAascrA C r-K gc.Ra—"`�
Address: S.--'1 7 S -1 C tO- � N Expiration Date:
Signature: QE2-� Telephone (1.eC "33 3
3.2 Homeowner Exemption- One&Two Family Only Section 110.R5.1.3.1 Exception:
FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT
Exception: Any Homeowner performing work for which a Building Permit is required shall be exempt from the provisions of this section;provides that if a Homeowner
engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor
For the purposes of this section only,a"Homeowner"is defined as follows: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which
there is,or is intended to be.a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than
one home in a Iwo-year period shall not be considered a Homeowner.
If you are applying under this section sign below:
Signature:
SECTION 4-WORKER'S COMPENSATION INSURANCE AFFIDAVIT(MGL c 152§25)
Worker's Compensation Insurance Affidavit must be completed and submitted with this application. Failure to provide this
affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached: WYes 0 No
SECTION 5-DESCRIPTION OF PROPOSED WORK(Check all applicable)
❑ Deck cool ❑ Repairs 0 Alteration 0 Chimney/Fireplace ❑ Woodstove/Pellet Stove
V
❑ New Construction* 0 Accessory Bldg. 0 Roofing/Siding 0 Other
(Energy report required) (Shed/Garage) (Specify below)
❑Addition 0 Replacement window/door 0 Demolition
(Energy report required) No. of windows Doors (Specify below)
*if new construction, please complete the following:
Single Family: No. of Bedrooms No. of Baths
Two Family: No of Bedrooms Unit 1 No. of Baths Unit 1
No of Bedrooms Unit 2 No. of Baths Unit 2
❑ Furnace(hot air)-fuel gas(natural or propane),fuel oil,electricity,other(specify):
• ❑Boiler(heating)-fuel gas(natural or propane),fuel oil,electricity,other(specify):
❑HVAC(combined unit)-primary fuel,natural gas,propane,electricity,other(specify):
❑Air conditioning-(separate unit)
0 None of the above to be provided
0 Hot Water: Gas Electric Fuel Oil Other
11
SECTION 6-ESTIMATED CONSTRUCTION COST
Item Estimated Cost($)to be completed by permit applicant
1. Building
2. Electrical
, 3. Plumbing
4. Mechanical (HVAC) i
5. Total=(1 +2+3+4) Lj
v SECTION 7A-OWNER AUTHORIZATI N
$ (to be completed when owner's agent or contractor applies for building permit)
(Pleas rint) �?
I, RTItLiG " ` a&IE , as Owner of the subject property hereby authorize "1Lt4 1"‘l U F SPPo
to act on my behalf, in all matterssrelative to work authorized by this building permit application.
Signature f Owner �� J Date
r'�
SECTION 78-OWNER/AUTHORIZED AGENT DECLARATION
I, AiNZns Paa LS , as Owner/Authorized Agent hereby declare that the statements and information
on the foregoing application are true and accurate,to the best of my knowledge and belief.
Si netLunder the pains and penalties of perjury.
re of Owner/Authorized Agent Date
,�A/� SECTION 8-OFFICE/INSPECTOR'S NOTES
(15 p (}'S} Less Application Fee: $25.00 Remaining Balance: $
Total Permit Fee:$ N„C-//t�u1 (f V
Other$Amount$
Gross Area- New Construction total sq.ft.
Gross Area-Alteration total sq.ft.
Permit Issued to:
F
SECTION 9-ADDITIONAL COMMENTS/SKETCHES
i3- idituiPtpX, $&./ '''`C`C"
5- 2-773 E CG&6e__ Aee ac
p
v1i71
permit No. BP-69852 Project Location: 3 WREN LN
Commonwealth of Massachusetts
TOWN OF DARTMOUTH G p# 3345.00
0066
400 Slocum Road,Dartmouth,MA 02747 Lot: 0002 f
Phone: (508)910-1820 • Fax:(508)910-1838 Subtot: 013'1,
BUILDING PERMIT CategProject#: iS 013-002463,
FIF.T ,D INSPECTION ; ee;t~oat $5800.00
Const Class:;
gnu Group. U
Contractor License: Phone#: Lot Size(sq:ft) 41000
AARON POOLS& SPA (508) 996-3320 Zoning: SRB
Engineer License: Phone#: Aquifer Zone: N/A
Applicant: Phone#: Flood Zone: ZONE X
KATHLEEN BOGIE (508)995-8660 New Const.: N/A
OWNER: - Alt.Const: N/A
BOGIE CHRISTOPHFILH
DATE ISSUED:
3
TO PERFORM THE FOLLOWING WORK:
Installation of a 21' above ground swimming pool with appropriate barriers
DATE TIME TYPE OF INSPECTION&REMARKS INITIAL
74>
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fie e . act ,e
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_tl= Office of Consumer Affairs and usiness Regulation
� .-`�_ 10 Park Plaza - Suite 5170
_
Boston, Massac ,lsetts 02116
Home Improvement 'l' ' tor Registration
Registration: 142323
, ,� Type: Private Corporation
z /$i,(7 Expiration: 3/26/2014 Trtt 222529
\
Aaron Construction Co. — — — ,
1 r
Paul Flanagan a --- }',
597 State Road
Dartmouth, MA 02747 '`
D i
7
r't4 S,,.e. Update Address and return card.Mark reason for change.
Address ❑ Renewal 0 Employment 0 Lost Card
DPS-CAI C. 50M-04/04-G101216
a Somm'meoecda p'ad°"'ri" 6 License or registration valid.for individul use only
Office of Consumer Affairs&B siness Regulation g
,E 1
. et HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
ie . 3 Registration -0-t42323 Type: Office of Consumer Affairs and Business Regulation e ;t( Expiration c3/26l2014 Piivate Corporation 10 Park Plaza-Suite 5170
'" ' ^�� 'rr Boston,MA 02116
Aaron Constructio; (U,- --_ p
61c
i -,
Paul Flanagan "± rr•.rt if;
s:C.y..t'ii f.iv
rt. _-.�;
597 State Road ,,. E��„�,.J ea
Dartmouth,MA 02747 rva'7,-i9` Undersecretary Not valid without signature
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The Commonwealth of Massachusetts
Department of Industrial Accidents
4 rwl eta Et Office of Investigations
600 Washington Street Boston, MA 02111
isr
� ••wri.sttwww.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): / f\lLbc C.,:NSfYLJLI l su-1
Address: Ct fl 7 rt. to-
City/State/Zip: $p cr-moal- vr,a . Phone #: (5o.s') °Sul Z, •332.0
Are you an employer? Check the appropriate box: Type of project(required):
lam a employer with / 4. ❑ I am a general contractor and I 6. ❑ New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. + 7• ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.0Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: / -[- . U•
Policy#or Self-ins. Lic. #: 5- g�' '33 'Y Expiration Date: 3• s
Job Site Address: `? (t i(k .f ( r • City/State/Zip: TYvtu.414 vi
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereb ` rub, der the pains pe !ties of perjury that the information provided above is true and correct:
(�
Signatur • ` Y� ' >I Date:
Phone#.. s' � l � 3 —2
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
- -c ' CERTIFICATE OF LIABILITY INSURANCE DATE iTYYYYp `�
03l27N3
THIS CERTIFICATE Is ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE Does NOT CON$11TUTE A CONTRACT BETWEEN THE ISSUING INSURER(SI, AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject io
the terms and conditions of the policy,OBRain policies may require an endorsement A Statement an this certificate does not center rights to She
certificate holder in lieu of such Ondotsement(B).
PROIYUC€R 508-954-16161 Noises �.Ka lanky-Fairhaven
208 Washington Street 508A84-7919 PH oxE EJ. ...____ IEINC Nc..
Fairhaven, 6 02799 PN` —_.
Actis ss;
Scott Barudin PRODUCER RYCRA-1
r a:DA
INSURERLSI AFFORDING COVERAGE NAICF
INSURED Rycram Construction CO.,Inc. )NSURERA:Nautilus Insurance Co
5S7 State ref
MUM 9:COmmeltle Ins Co ,___ . . _
Dartmouth,MA 02747 INsuRr-Rc:AIG-American International Gr
Aaron Pools&spas .
597 State Rd INsuaEA 0: . .. _
Dartmouth,MA 02747 wsuRER E: -
- .
IR6UAER F: _.
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
I THIS 1$TO CP_RTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO DiE INSURED NAMED ABOVE FOR THE POLICY PEP100
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
{ EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. , ,,,..
n�R TYI£OF INS
OF WV I.OI POLICY NUMBER DDIYYYYI P CJFIY OCPI LIMITS
GENERAL LwDIIJYY FAGH OCCURRENCE $_...,..... 1,000,00C,CNAGE O RLNI'U
A X COMMERCIAL GENERAL LIABILITY NC649G08 06/05112 0WOWSo P IyE QJ yL q 100,Dlif
__— CLAaas-MADE X OCCUR I MED E)1P[Any Pie person) ... $ 53OOC
'PERSONAL aAZV INJURY 6 1,000,0O(
GENERAL AGGREGATE 3 2,000,00(
GENL AGGREGATE LIMB APPLIES PER PRQOUCT$-COMP,OP AGG 6 I,000,00(
CY
7UTOOu�LIABILITYI LOG 5 1,000,001
COMBINED SINGLE DEBTB ANY AUTO BRSL2e 03/16/13 03/18/14 (Es ec�-AeF1m1 , -.
OOPILY INJURYIPnr peen) I:
X ALL OUMEDNJTOS BODILY INJURY(Per exidnnil 5. ...
X SCtl3/DLEO AUTOS I $ROPERTVDANAGE $
HIRED AUTOS (Per aeadenD ...__ .
NON-OWNED ALTOS S -_
i
6
umerte ALMP - OCCUR I EACH OCCURRENCE 16 _ ..._.
FRCVSS DAB CLAIM$-I.ADE I AGGREGATE 5
DEDUCTIBLE _ ... S .. ---
R,L T. _ .._ S
WORKERS COMPENSATION 1
X I TYdr-
dQ OETCi__AND EMPLOYERS'W19111 YC ANYPROPRIETORPARTNER/EXECUTTV6
El x/A 005584234 OaD5012 02/25/14 eLEACH=ma s S00,001
OFFICERITIEMBER EXCLUDE%
(Myznaidvlesry In NH) Et018EADE-EA EMPLOYEES 5001001
I IT I DESCRIPTION ON OPERATIONS pnEw ,EL DISEASE-POLICY LIMIT 5 600,001
l _
DESCRIPTION OF OPERATIONS/LOCATIONS)VEHICLES (*Eh A PARD 101,ASiMIMI l Rnraance Scnldara,It mart:grace B rarse:ise
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
TOWN OF DARTMOUTH ACCORDANCE WITH THE POLICY PROVISIONS.
SLOCUM ROAD
DARTMOUTH, MA 02747 At:MOE:WED REP1U SENTATFJE
I 1�'
0 1980.2009 ACORD CORPORATION. All rights reserved.
ACORU 25(2009IOS) The ACORD name and loge are Registered marks of ACORD
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